title: Evaluation of use of stage of tobacco epidemic to predict post-immigration smoking behaviors.
abstract: BACKGROUND
  This research uses the Lopez stage of tobacco epidemic model to evaluate post-immigration smoking behavior. Stage is a composite measure of tobacco norms of a country: smoking prevalence, cigarette consumption, and tobacco-related morbidity. The Lopez model characterizes the changing relationship between smoking prevalence and tobacco-related mortality and morbidity as a country progresses through the 4 successive stages of the tobacco epidemic.
  
  
  METHODS
  Survey data from Southeast Asian and Latino immigrants (from stage 1 and stage 2 countries) (n = 2,076) were used to evaluate stage of tobacco epidemic of country of emigration. Stage was compared with standard acculturation measures and community identification measures to understand post-immigration smoking behavior in the United States. Comparative analysis by stage and gender includes bivariate associations and logistic regression models to predict post-immigration smoking behavior.
  
  
  RESULTS
  Males:Pre-immigration prevalence and consumption rates of our study sample conform to prevalence and consumption of stage 1 and stage 2 countries predicted by the Lopez model. Post-immigration smoking uptake is equivalent to pre-immigration uptake for stage 1 males. The uptake rate for stage 2 males post-immigration is significantly lower (22.1%) than pre-immigration uptake (41.4%). Stage is a statistically significant predictor of post-immigration smoking uptake (OR = 3.08, CI = 1.82-5.22, p < .01). Females:Stage of country of birth is not significantly predictive of post-migration smoking uptake.
  
  
  CONCLUSIONS
  The finding of stage to be a strong predictor of post-immigration smoking behavior among males provides a promising measurement tool. Prevalence and consumption of females in our study sample support the need for revisions to the stage model.
authors.affiliation: Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI;
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Constantine
authors.forename: Oluwakayode O
authors.initials: OO
authors.lastname: Adejoro
authors.forename: Joanne
authors.initials: J
authors.lastname: D'Silva
authors.forename: Todd H
authors.initials: TH
authors.lastname: Rockwood
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Schillo
mesh_terms: D000069:Acculturation; D000328:Adult; D001210:Asia, Southeastern / Q000208:ethnology; D003625:Data Collection; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006630:Hispanic or Latino / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality